thyroid 3

Question 1

hyperthyroidism also called

Answer 1

thyrotoxicosis

Question 2

hyperthyroidism is

Answer 2

hyper metabolic state due to excess T3 and T4

Question 3

symptoms of hyperthyroidism

Answer 3

nervousness, anxiety, increased perspiration

heat intolerance, hyperactivity, palpitations

Question 4

signs of hyperthyroidism

Answer 4

• tachycardia or atrial arrhythmia
• systolic hypertension with wide pulse pressure
• warm, moist, smooth skin
• lid lag
• stare
• hand tremor
• muscle weakness
• weight loss despite increased appetite
• reduction in menstrual flow or oligomenorrhoea

Question 5

hyperthyroidism causes

Answer 5

• diffuse hyperplasia - graves disease
• hyper functional multi nodular goitres
• hyper functional thyroid adenoma

Question 6

less common hyperthyroid causes

Answer 6

• hashitoxicosis - early phase of hashimotos
• iodine overload
• central - TSH mediated, pituitary adenoma
• paraneoplastic - germ cell tumours
• drugs - lithium, thyroxine

Question 7

hyperthyroidism younger patients tend to exhibit symptoms of

Answer 7

sympathetic activation - anxiety, hyperactivity, tremor

Question 8

hyperthyroidism in older patients

Answer 8

cardiovascular symptoms

dyspnoea, atrial fibrillation and unexplained weight loss

Question 9

graves disease

Answer 9

autoimmune disease of women age 20-40
common in community
genetic factors
autoantibodies against TSH receptor and other thyroid antibodies
- most patients have thyroid stimulating immunoglobulin TSI
- minority have TSH receptor blocking antibodies (may paradoxically lead to hypothyroidism)
- thyroid can be extremely large - leads to functional symptoms and mass effect

Question 10

enlarged thyroid in graves disease

Answer 10

functional symptoms and mass effect
often have more marked symptoms than patients with thyrotoxicosis from other causes and several characteristic findings (pretibial myxoedema and opthalmopathy)

Question 11

macroscopic graves disease

Answer 11

enlarged thyroid, diffuse and uniform enlargement involving all of the gland, without evidence of nodule formation or significant fibrosis

Question 12

histological graves disease

Answer 12

epithelial hypertrophy and hyperplasia with papillary formations and scalloped colloid gland usually 100-150g, but may be larger

Question 13

opthalmopathy in graves disease

Answer 13

• periorybital oedema, lid lag, lid retraction, diplopia or proptosis
• characteristic but not always present in graves disease due to inflammation and deposition of collagen and glycosaminoglycans with secondary fibrosis within the orbit
• not reversible

Question 14

pretibial myxoedema

Answer 14

graved dermopathy

accumulation of myxoid mucopolysaccharides in subcutaneous tissue - alcian blue stain stains mucopolysaccharide material

Question 15

nodular colloid goitre - early stage

Answer 15

usually euthyroid
simple diffuse/nontoxic colloid goitre
most are endemic, iodine deficiency
minority are sporadic - genetic or acquired problems with hormone synthesis, usually idiopathic - more common with women
- hyperplasia of the thyroid follicles - nodules within the thyroid

Question 16

most nodule colloid goitres are caused by

Answer 16

iodine deficiency - common in Australia

Question 17

reduced available iodine leads to

Answer 17

less hormone production

Question 18

other things reducing hormone production

Answer 18

goitrogens - drugs, foods

brassicaceae family inc cabbage, cauliflower, broccoli, kale, cassava etc

Question 19

later stage of nodular colloid goitre

Answer 19

cycles of hyperplasia and involution lead to nodule formation, with some areas demonstrating benign clonal proliferation
areas of follicular hyperplasia, inflammation, haemorrhage, fibrosis
forms ill defined nodules
can have dominant nodules
can be hyper, hypo or euthyroid